Free MDOS Form - Michigan

BLD-200 (11/2006) Michigan Dept. of State 1-888-SOS-MICH (1-888-767-6424)

Clear Form

APPLICATION FOR IMMEDIATE NEED MECHANIC TESTING
(Testing available only at the Licensing Unit in Lansing) APPLICATION REQUIREMENTS:
1. Application must be filled out by the requesting registered repair facility and faxed to the Licensing Unit at: (517) 335-2810. 2. Applicant must have an offer of employment from a registered repair facility. Applicant must take immediate action to obtain State of Michigan mechanic certification. 3. Test(s) will not be administered without a scheduled appointment, valid photo ID, and receipt of this application.

ALL INFORMATION BELOW IS REQUIRED AND MAY BE VERIFIED APPLICANT:
Applicant Name (Please Print): ___________________________________________ SSN: ______________________ Address: __________________________________ Telephone: ( City: ___________________ State: ________ Zip: _______

) ____________________

_____________________________________________________ Signature

EMPLOYER:
Repair Facility Name: ____________________________________________ Address: __________________________________ Telephone: (

) ______________
Zip: _______

City: ___________________

State: ________

EMPLOYER VERIFICATION:
Michigan Repair Facility Registration Number:

F___________________

I verify that an offer of employment, valid until ______/______/_________, has been made to the above named applicant contingent upon passing the tests indicated below and applying for Michigan mechanic certification. Employer Name (Please Print): _______________________________________________________________________ Employer Signature: _____________________________________ Title (owner, manager, etc.): _________________

CERTIFICATION REQUIREMENTS: You may select a maximum of three (3) certification categories for immediate need
testing of this applicant. Additional tests may be taken at designated Secretary of State branch offices, if needed.

Automobile & Light Truck Engine Repair Automatic Transmissions Manual Transmissions Front End & Steering Systems Brakes & Braking Systems Electrical Systems Heating & Air Conditioning Engine Tuneup/Performance

Heavy Duty Truck Engine Repair ­ Gasoline Engine Repair ­ Diesel Drive Train Brakes & Braking Systems Suspension & Steering Systems Electrical Systems

Other Pre-1973 Vehicles Unitized Body Structural Repair Collision-Related Mechanical Repair Motorcycle Recreational Trailer